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The medical literature is replete with references to illnesses thought to be based on emotional disorders Careful examination of clinical material discloses that a diversity of phenomena are being so classi ed: anxiety states, cycles of depression and mania, reactions to distressing life situations, so-called psychosomatic diseases, and illnesses of obscure nature Obviously great license is being taken with the term emotional, the result no doubt of its indiscriminate nonmedical usage Such ambiguity discourages neurologic analysis Nevertheless, in certain clinical states, patients appear to be excessively apathetic or elated under conditions that are not normally conducive to such displays of emotion It is to these disturbances that the following remarks pertain First, however, one must be clear as to what is meant by emotion Emotion may be de ned as any strong feeling state eg, fear, anger, excitement, love, or hate associated with certain types of bodily changes (mainly visceral and under control of the autonomic nervous system) and leading usually to an impulse to action or to a certain type of behavior If the emotion is intense, there may ensue a disturbance of intellectual functions that is, a disorganization of rational thought and a tendency toward a more automatic behavior of unmodulated, stereotyped character In its most easily recognized human form, emotion is initiated by a stimulus (real or imagined), the perception of which involves recognition, memory, and speci c associations The emotional state that is engendered is mirrored in a psychic experience, ie, a feeling, which is purely subjective and known to others only through the patient s verbal expressions or by judging his behavioral reactions This behavioral aspect, which is in part autonomous (hormonal-visceral) and in part somatic, shows itself in the patient s facial expression, bodily attitude, vocalizations, or directed voluntary activity, an observable display for which we use the term affect Subdivided, the components of emotion appear to consist of (1) the perception of a stimulus, which may be internal (an idea) or external, (2) the feeling, (3) the autonomic-visceral changes, (4) the outward display of affect, and (5) the impulse to a certain type of activity In many cases of neurologic disease, however, it is not possible to separate these components from one another, and to emphasize one of them does no more than indicate the particular bias of the examiner Obviously, neural networks of both affective response and cognition are involved.

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The occurrence of abnormal emotional reactions in the course of disease is associated with lesions that preferentially involve certain parts of the nervous system These structures have been grouped under the term limbic and are among the most complex and least understood parts of the nervous system The Latin word limbus means border or margin Credit for introducing the term limbic to neurology is usually given to Broca, who used it to describe the ring of gray matter (formed primarily by the cingulate and parahippocampal gyri) that encircles the corpus callosum and underlying upper brainstem Actually, Thomas Willis had pictured this 442

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region of the brain and referred to it as the limbus in 1664 Broca preferred his term, le grand lobe limbique, to rhinencephalon, which was the term then in vogue and referred more speci cally to structures having an olfactory function Neuroanatomists who followed Broca af rmed his position and have extended the boundaries of the limbic lobe to include not only the cingulate and parahippocampal gyri but also the underlying hippocampal formation, the subcallosal gyrus, and the paraolfactory area The terms visceral brain and limbic system, introduced by MacLean, have an even wider designation and more completely describe the structures involved in emotion and its expression; in addition to all parts of the limbic lobe, they include a number of associated subcortical nuclei such as those of the amygdaloid complex, septal region, preoptic area, hypothalamus, anterior thalamus, habenula, and central midbrain tegmentum, including the raphe nuclei and interpeduncular nucleus The major structures comprised by the limbic system and their relationships are illustrated in Figs 25-1 and 25-2 The cytoarchitectonic arrangements of the limbic cortex clearly distinguish it from the surrounding neocortex (isocortex) The latter, as stated in Chap 22, differentiates into a characteristic six-layered structure In contrast, the inner part of the limbic cortex (hippocampus) is composed of irregularly arranged aggregates of nerve cells that tend to be in a trilaminate con guration (archi- or allocortex) The cortex of the cingulate gyrus, which forms the outer ring of the limbic lobe, is transitional between neocortex and allocortex hence it is known as the mesocortex, or juxtallocortex Information from a wide array of cortical neurons is funneled into the dentate gyrus and then to the CA (cornu ammonis) pyramidal cells of the hippocampus; output from the hippocampal formation is mainly from the pyramidal cells of the CA1 segment and subiculum The amygdaloid complex, a subcortical nuclear component of the limbic system, also has a unique composition, consisting of several separable nuclei, each with special connections to other limbic structures The connections between the orbitofrontal neocortex and limbic lobes, between the individual components of the limbic lobes, and between the limbic lobes and the hypothalamus and midbrain re ect their many functional relationships in regard to emotion At the core of this system lies the medial forebrain bundle, a complex set of ascending and descending bers that connect the orbitomesiofrontal cortex, septal nuclei, amygdala, and hippocampus rostrally and certain nuclei in the midbrain and pons caudally This system, of which the hypothalamus is the central part, was designated by Nauta as the septohypothalamomesencephalic continuum There are many other interrelationships between various parts of the limbic system, only a few of which can be indicated here The best-known of these is the so-called Papez circuit It leads from the hippocampus, via the fornix, to the mammillary body and septal and preoptic regions (Fig 25-1) The bundle of Vicq d Azyr (mammillothalamic tract) connects the mammillary nuclei with the anterior nuclei of the thalamus, which, in turn, project to the cingulate gyrus and then, via the cingulum, to the hippocampus The cingulum runs concentric to the curvature of the corpus callosum;.

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it connects various parts of the limbic lobe to one another and projects to the striatum and to certain brainstem nuclei as well Also, the cingulum receives bers from the inferior parietal lobule and temporal lobe, which are multimodal suprasensory centers for the integration of visual, auditory, and tactile perceptions It is connected to the opposite cingulum through the corpus callosum

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